The pain, immobility, and general disability associated with osteoarthritis are familiar to most people who reach old age. Post-traumatic osteoarthritis (PTOA) is a profoundly accelerated form of arthritis associated with traumatic injuries to joint articular surfaces, leading to disease progression well before patients are considered good candidates for joint replacement approaches common to orthopaedic medicine. Because patients are often injured relatively young and there are presently no viable alternatives to joint replacement, patients with PTOA often suffer disability and morbidity comparable to chronic heart disease patients.
Natural methods for treating PTOA include decreasing load and stress on the injured joint or increasing comfort and functionality. For example, weight loss, low impact exercise, and strengthening muscles surrounding the joint may improve PTOA. However, these approaches do not cure or prevent PTOA and may not be fully effective.
Non-steroidal, anti-inflammatory medicines (NSAIDS) are used to decrease pain and inflammation associated with PTOA, although NSAIDs can cause stomach irritation and kidney, liver or heart problems. Moreover, NSAIDs likely do not prevent PTOA. Antioxidants, another class of compounds used to treat PTOA, stabilize or deactivate reactive oxygen species (ROS) before they attack cells. Nevertheless, there is skepticism about the benefit of antioxidants and there are potentially harmful side effects if anti-oxidants are taken in excess.
Other methods used to treat PTOA include the administration of cortisone and hylamers which act like artificial joint fluid after injection. However, cortisone can cause elevation of heart rate and blood sugar and should not be given too often. In addition, cortisone is not preventative. While corticosteroid injections are anti-inflammatory, the potential benefit or adverse effects of that injection for traumatic injury have not been resolved. Another approach is the use of platelet-rich plasma injections.
Injection of a patient's own platelets leads to release of growth factors and attraction of regenerative cells to the site of injury. This type of injection is not preventative and does not work for all PTOA patients. Moreover, details on dosage, frequency of injection, and other important parameters have yet to be worked out for platelet rich plasma administration. A further type of injection is an amniotic membrane stem cell injection. While this injection is anti-inflammatory, thus providing pain relief, and results in replacement of damaged cells due to release of growth factors, it is not preventative and does not target ROS.
If non-surgical methods are ineffective, surgical methods may be employed to restore the joint after PTOA. The surgery may include cleaning out, reconstructing or replacing the worn out joint surfaces. As with other surgeries, there can be surgical complications, e.g., infection and damage to surrounding structures, blood clots, heart attack, and stroke, and the eventual wearing out or loosening of implants.